Medicare

Whether or not your doctor stays in business over the next few years could hinge on their ability to adapt to a new regulation changing how Medicare pays doctors and clinicians.

The game-changing regulation aimed at paying medical providers for quality instead of quantity is known as MACRA. It’s based on legislation passed last year by Congress to overhaul how Medicare pays doctors.

There are two routes medical providers can take: Medical practices can earn higher reimbursements if they learn new ways of doing business. That includes being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records. The majority of medical practices will go this route, according to the Kentucky Medical Association.

Or they can join a network of medical providers and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending.

Kentucky has joined a multi-state and federal fraud lawsuit against Cincinnati-based Omnicare Inc., alleging that the company billed the state’s Medicaid program almost $6 million over nine years for drugs that were given to nursing home patients for uses not approved by the Food and Drug Administration.

According to papers filed by Attorney General Jack Conway in federal court in Abingdon, Va., Omnicare received “millions of dollars” in kickbacks from Abbott Laboratories for promoting the use of Depakote, an anti-seizure and mood-disorder drug, for dementia patients who were agitated or aggressive. The suit says Omnicare defrauded state Medicaid programs by billing for the illegally administered drugs.

The complaint is Conway’s third kickback case against Omnicare, which moved its headquarters from Covington in 2012. Omnicare spokesman Patrick Lee did not return a phone call Monday.

The company paid $98 million in 2009 to settle claims it took kickbacks from drug makers Johnson & Johnson and IVAX. It paid $8.2 million in 2014 to settle claims it paid kickbacks to nursing homes in return for their pharmacy business.

Abbott Labs settled the Virginia case by paying a $1.5 billion settlement in 2012, about $3 million of which went to Kentucky. Another institutional pharmacy operator named in the case, Louisville-based PharMerica, has agreed to settle out of court for an unspecified amount.

The Obama administration said Monday that it wants to speed up changes to Medicare so that within four years half of its traditional spending will go to doctors, hospitals and other providers that coordinate patient care.

The shift is being made to stress quality and frugality over payment by the procedure, test and visit.

A new poll finds a majority of Kentuckians aren’t happy with the Affordable Care Act, but they do like benefits the legislation made possible.

According to the Foundation for a Healthy Kentucky study released Thursday, this disconnect is consistent throughout the state, although people in the more urban areas—Lexington and Louisville—were at least nearly 10 percent more favorable of the ACA.

The foundation’s President Susan Zepeda says the poll found nearly half of people disapprove of the ACA while nearly 4 out of 5 like one of the benefits.

“The biggest difference we found was the number of Kentuckians who strongly supported the expansion of Medicaid that was made possible by the Affordable Care Act,” she said.

Faced with the possibility of a Republican super majority in both chambers of the Tennessee General Assembly, Democratic candidates are aggressively attacking their opponents in legislative races across the state.

Kentucky Governor Steve Beshear is not joining other Kentucky officials in calling for the repeal of the Affordable Care Act. Many leading Republicans in the state—including Senate Minority Leader Mitch McConnell—have pushed for full repeal of the healthcare law. But in an interview with NPR, Beshear said they're playing politics.